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Smart States and the Push towards Health IT Modernization
Session # 96 | February 13, 2019
Darshan Shah (Indiana) | Jared Linder (Indiana) | Mylynn Tufte (North Dakota)
Dr. Shereef Elnahal (New Jersey) | Gerd Clabaugh (Iowa)
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• Indiana:
Darshan Shah, Chief Data Officer, State of Indiana
Jared Linder, CIO, Indiana Family and Social Services
Administration
• North Dakota: Mylynn Tufte, State Health Officer
• New Jersey: Shereef Elnahal, MD, Commissioner of
Health
• Iowa: Gerd Clabaugh, Director, Iowa Department of Public
Health
Panelists
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• Illustrate new pathways toward the evolution of strong and
adaptable state health systems
• Describe federal and state-focused policy initiatives that
may strengthen states’ health IT infrastructure through
Medicaid modernization, Public Health 3.0
• Discuss the application of 21st Century healthcare and
innovative technologies and cross-sector data informs
public policy and smarter community-level responses
Learning Objectives
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Smart States and the Push towards Health IT Modernization
Session # 96 | February 13, 2019
Asif Dhar, MD, MBA Co-Moderator
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Four key areas in which smart technologies can help Medicaid
agencies improve
• Promotion of independent living.
• IoT can be used to help promote independent living through RPM supported by
intelligent agents.
• Customer service.
• Technologies such as chatbots, enabled by machine learning, can offer quick
answers to routine questions and help facilitate more complex tasks.
• Targeted interventions.
• Machine learning and GIS, which draw on multiple data sets in real time, can
help program administrators identify patient populations who are at risk of
costly or adverse health outcomes and develop interventions.
• Program operations.
• GIS can help Medicaid agencies enforce network adequacy to promote better
access to care, and how the IoT can integrate ridesharing technology into
Medicaid platforms to improve non-emergency medical transportation (NEMT)
services.
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Why modular and interoperable Medicaid platforms?
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Opportunities:
• Virtual care can be used to address access barriers related to transportation and
provider shortages, and to make health care visits more convenient.
• Wearables can be used to help providers and patients work together to monitor
conditions and track patient activity, mood, and symptoms.
• Mobile health apps can be used to help manage the health care of pregnant
women, and people with behavioral health conditions, disabilities, or social
needs.
Digital health tools for Medicaid beneficiaries must address the following
challenges:
• Medicaid beneficiaries may have limited data usage/ may run out of data
toward end of month in PAYGO plans.
• Devices may be several generations old and be slower or have lower
functionality than newer phones.
• Health literacy and literacy in general may be lower in the Medicaid
populations.
• Individuals with disabilities (30 percent of nonelderly adult Medicaid
beneficiaries)
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Smart States and the
Push Towards Health IT Modernization
Session #96, February 13, 2019
Darshan Shah, Chief Data Officer, State of Indiana
Jared Linder, CIO, Indiana Family and Social Services Administration
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Indiana Data Hub
Current Topics
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datasets
How is the data organized?
• Developed using the CKAN open-source platform
• Provides self-service web-based access to valuable information
maintained by Indiana State Government
• Available as CSV and/or PDF files
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Medicaid
• More than 1.4 million Hoosiers are registered for Medicaid
• In 2017, that amounted to more than 47 million claims
• Total spend = more than $10 billion
• With more than 7,500 dataset downloads, this equates to more than
60,000 staff hours (30 full-time employees) responding to public
information requests
Over the past twelve
months the Indiana
Medicaid datasets
have drawn:
7,500
Dataset views and downloads
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Visitors affiliated with academic institutions
Visitors affiliated with federal, state or municipal government agencies
Visitors affiliated with hospitals and other healthcare providers
Visitors affiliated with private sector businesses
Visitors affiliated with non-profit organizations
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Darshan Shah and Jared Linder have no real or apparent conflicts
of interest to report.
Conflict of Interest
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Smart States and the
Push Towards Health IT Modernization
Session #96, February 13, 2019
Mylynn Tufte, MBA, MSIM, RN
State Health Officer, North Dakota Department of Health
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EMPOWER PEOPLE
IMPROVE LIVES
INSPIRE SUCCESS
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Reinventing
Government
Autonomous
Systems
Main Street
Initiative
North Dakota IT Transformation
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Ju
l
May
Au
g
Oct
Source: https://www.governor.nd.gov/news/burgum-announces-30-
million-uas-infrastructure-proposal-support-statewide-beyond-visual-line
First trans-Atlantic
flight of a medium-
altitude, long
endurance UAS flew
from Grand Forks,
ND to England –
3,760 nautical miles
in 24 hours, 2
minutes.
ND selected as
one of 10 UAS
Integration Pilot
Programs
First flight of a large
UAS operating
Beyond Visual Line
of Sight (BVLOS)
without the use of a
chase plane in
controlled airspace
First public mission
of the UAS
Integration Pilot
Program with a
drone flight over a
tailgating event at
the Fargodome.
No
v
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• Workforce
utilization and
improved quality
of life
Autonomous
systems will
continue to
have great
health and
policy impacts
for North
Dakotans and
the nation.
• Increased
security &
surveillance
• Increased
safety
Benefits of UAS:
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Mylynn Tufte, MBA, MSIM, RN
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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The New Jersey Health Information Network:
Interoperability as a Public Good
Session 96, February 13, 2019
Shereef Elnahal, MD, MBA
New Jersey Health Commissioner
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Shereef Elnahal, MD, MBA
New Jersey Health Commissioner
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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The New Jersey Health Information
Network (NHIN)
1) Daily collection of
a) Demographic Data
b) Rx Data (PMP/SureScripts)
c) Claims Data
d) HIO/Hospital EMR data
2) Every Patient Admitted in
ED/seen in clinic generates an ADT
alert to NJHIN
3) Clinical information tied
back to the Master Person
Index (MPI)
Value delivered with clinical
and public health use cases.
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Public Health Data Use Cases
Electronic Case Reporting
Immunization registry reporting use cases leveraging HIN with public access
Current
Manual outreach by public health
to providers for case specific
information
Duplicative data entry across
systems
Siloed data exchange and
transformation process
Data quality issues across
systems
Future
• Update registries to leverage HIN Identity
(MPI)
• Interoperability platform amongst state
datasets
• Electronic reporting replaces manual
outreach
• Implement Clinical Decision Support
framework
• Consumer (patient/next of kin) access to
immunization data
• Exchange data leveraging FHIR/ CDA
standards
• API driven architecture
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Enhanced Opioid Dashboard for
Actionable Policy Decisions
Essex County: Demand
• Drug-related deaths: 271
• Drug-death rate (per 100,000):
33.9
• Naloxone Incidents: 739
• Rate of substance use
admissions (per 100,000):
1,091
• Number of first time
admissions: 8,773
• Drug-related hospital visits
(rate per 100, 000): 101.5
• Opioid prescription rate (per
100): 44.8
• Arrests (possession/use): 4,937
• Arrests
(sale/manufacture):1684
Essex County: Supply
• Inpatient treatment capacity
(available beds)
• Ambulatory treatment capacity
(SUD clinics, AWD services,
etc.)
• Primary care/family medicine
provider slots (Outpatient-
Based Addiction Treatment, OR
OBAT)
• Emergency rooms with
suboxone induction
• Peer recovery specialist supply
• Syringe access program
capacity
• ALTO-trained emergency
rooms
• ALTO-trained providers
Smarter Policy
Decisions:
• SUD/integrated
license prioritization
by region
• Targeted OBAT
training to providers
• Targeted
deployment of
opioid alternative
training to providers
• New syringe access
program locations
• Targeted
deployment of ALTO
training
* All data is 2016 data, with exception of Nalaxone incidents, which is 2017 data.
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Maternal Mortality Use Cases
The Perinatal Risk Assessment (PRA) form - risk assessment
tool for pregnant women
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Smart States and Iowa’s Push towards
Health IT Modernization
Session 96, February 13, 2019
Gerd Clabaugh, Director, Iowa Department of Public Health
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Gerd Clabaugh, MPA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Technical Debt
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Integrate 8 program systems into 1
Benefit of Consolidation
• Lower future cost of reinvestment
• Improved analytics
• Improved user experience
Impact on Iowans
• “…the dental hygienist delivering oral cares to a child can additionally see that the
family may not have insurance, may have a financial burden, and may (need) other
resources – such as food resources. All of these notations are easily and quickly
accessible. Staff no longer have to respond with “we will get back to you after we
make some calls”. We are able to connect the family immediately with our hawk-i
coordinator or see in the notes the last time the family utilized the food pantry, check
on immunizations, oral care, medical home, and provide and make immediate
referrals and care coordinate needed services…”
Family Health Project
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Gerd Clabaugh, MPA
Director, Iowa Department of Public Health
Questions
